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Personalised External Aortic Root Support (PEARS): Our Preliminary Single Surgeon Results on 100 Patients
May 14, 2022
Aortic Symposium Workshop Boston, Boston
Sheraton Boston, Back Bay AB
Personalised External Aortic Root Support (PEARS) has been used since 2004 as a technique to stabilise aortic root dilatation in Marfan's root disease. Starting in 2012 we have developed this procedure to include other aortopathies, and as a free root Ross autograft support. The graft consists of a bespoke polyester mesh, created from the CT scan measurements of the patient's own aorta to prevent aortic dilatation by providing an exact anatomical external aortic support.
We present our single surgeon institutional experience on the first 100 patients undergoing PEARS procedure, recording the underlying diagnosis, the family history of acute aortic syndrome, the degree of pre and post-operative aortic regurgitation, the pre and post-operative aortic root dimensions, and the type of operation performed.
Our institution started PEARS in 2012. Patients aged from 9 to 73 years. In our 100 patients we now have 5 distinct groups: 1) Dilatational aortopathy as Marfan's disease, Loeys-Dietz syndrome etc (52%) 2) Dilatational bicuspid valve aortopathy with functional aortic valve (10%) 3) Aortopathy associated with congenital heart disease: Post arterial switch, cono-truncal repairs (7%) 4) Free root Ross autograft support, so called Ross PEARS procedure (29%) 5) Free root autograft dilatational recovery with reduction PEARS application (2%).
In groups 1-3 the mean aortic root dimensions (max measurement) preoperatively was 4.67cm, ranging from 3.7 to 6.2 cm. Most aortopathy cases were performed off cardiopulmonary bypass with 4 resorting to CPB to facilitate graft insertion. The immediate postoperative aortic measurements showed a mean reduction of 0.82 cm (ranging 0 to 2.3 cm). Six patients had a significant reduction of their preoperative aortic regurgitation by deliberate application of a reduced size PEARS.
There was one early death due to right heart failure after concomitant Ebstein's repair and one late death from Covid-19. There has been no progressive aorta dilatation. There have been 3 late aortic valve replacements, 2 early Ross PEARS support and 1 cono-truncal dilatational aortopathy. There were no coronary artery injuries.
PEARS can be used in a wide range of dilatation aortopathies or as a support for the pulmonary autograft in Ross operations. We have proven it to be safe operation which can be performed off cardiopulmonary bypass in most cases of simple aortopathies. Application of a reduced size PEARS has the additional benefit of correcting mild or moderate central trileaflet aortic regurgitation. Our pioneering development of groups 4 and 5 are predicted to have a major impact on widening the patients suitable for Ross surgery and in treating the failing free root Ross dilatation
Ana Redondo (1), Conal Austin (2), (1) Evelina London Children's Hospital, London, (2) Evelina London Children's Hospital, London, Greater London
Degree in Medicine and Surgery. Universidad de Valencia. Spain (2005-2011)
Speciality training in Cardiovascular Surgery. Hospital Ramon y Cajal. Madrid, Spain (2021-2017)
Attending surgeon in Congenital Cardiovascular Surgery. Hospital Ramon y Cajal - Hospital La Paz. Madrid, Spain (2017)
Clinical Fellow in Paediatric Cardiac Surgery. Great Ormond Street Hospital. London, United Kingdom (2018-2019)
Senior Clinical Fellow in Congenital Adult and Paediatric Cardiac Surgery. Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust. London, United Kingdom (2019-present)
PhD Student at Universidad de Alcala. Madrid, Spain (2018-present)
Special interest in congenital heart disease and inherited aortopathies